EFFECT OF ENALAPRIL ON PROTEINURIA AFTER KIDNEY-TRANSPLANTATION

We studied the effect of enalapril, an inhibitor of angiotensin-conver ting enzyme (iACE), on proteinuria and renal function in recipients of renal allografts. Twenty-two patients with post-transplant nephrotic syndrome were treated with incremental doses of enalapril for 1 year. Urinary protein excretion decreased after 2 months of treatment from a mean of 8.9 g/day (range 4.0-18.9 g/day) to 4.5 g/day (range 0.4-10.0 g/day; P < 0.01) and remained significantly low for the rest of the s tudy. However, in the same period, creatinine clearance did not change significantly; it went from 47.8 ml/min (range 17.1-110.3 ml/min) bef ore treatment to 44.2 ml/min (range 16.5-88.5 ml/min) after 2 months o f iACE therapy. Analysis of individual data showed that there was a si gnificant reduction in proteinuria in 14 of the 22 patients and that t he rate of deterioration of renal function did not increase in 17 of t he 22 patients. We did not observe any serious side effects of enalapr il administration. The results of our study prove that iACE can be use d safely and effectively to reduce post-transplant proteinuria.